I recently completed and tentatively failed an employment skills test for an EMT-B position. I say "tentatively" as there is a possibility of changing that result.
Here's the tested scenario on a mannequin:
Elderly female, unknown to witnesses (thus, no medical history available), passes out and hits head on pavement. EMS (in this case, oddly, EMT-B
) is called. Patient presents as bleeding from the back of the head, labored and abnormal breathing with abnormal flexion positioning - arms rigid and pointing inward. This was later describe to me as decorticate positioning. Patient is conscious, non verbal with eyes tracking movement.
I took the correct steps for c-spine precautions, instituted BVM w/ 15 lpm O2 and controlled the bleeding. I indicated priority transport due to the trauma and breathing difficulty, but suggested a rapid (<2 mins) trauma assessment to uncover any potential hidden injuries prior to packaging.
This was all done quickly and correctly, and a full set of vitals indicated diverging BP of 200/40, pulse of 50 and normal resperations w/BVM. Skin was warm pink and clammy, pupils PERLL. We packaged and I indicated code 3 transport to nearest trauma center.
Where did I fail? They said because I never directly indicated unstable patient do to probably closed head injury, as indicated by the decorticate positioning and blood pressure. I have a couple of issues with this:
1. Even though I never mentioned the probability of closed head injury, I did indicate the need for priority, code 3 transport. Why would an specific diagnosis be critical? The signs and symptoms alone indicated the critical nature of the injury. Knowing the cause wouldn't have gotten the patient to the ER any faster.
2. The EMT course I took used the AAOS EMT-B textbook. Nowhere does it use the term decorticate positioning or say that diverging BP is a sign of closed head injury . It DOES mention abnormal flexion as part of the GCS scale, and obviously somebody positioning themselves like this is suffering from some sort of brain injury. The BP divergence is NOT mentioned.
I suspect this is not within the normal scope of EMT-B education, at least not in the AAOS book. Would somebody who took the course using the Brady (or similar) book PLEASE see if it is covered.
Again, I stated the need for priority transport and did nothing to endanger the patient. All other steps were performed correctly. Am I wrong to debate the failing grade?
Here's the tested scenario on a mannequin:
Elderly female, unknown to witnesses (thus, no medical history available), passes out and hits head on pavement. EMS (in this case, oddly, EMT-B
) is called. Patient presents as bleeding from the back of the head, labored and abnormal breathing with abnormal flexion positioning - arms rigid and pointing inward. This was later describe to me as decorticate positioning. Patient is conscious, non verbal with eyes tracking movement.I took the correct steps for c-spine precautions, instituted BVM w/ 15 lpm O2 and controlled the bleeding. I indicated priority transport due to the trauma and breathing difficulty, but suggested a rapid (<2 mins) trauma assessment to uncover any potential hidden injuries prior to packaging.
This was all done quickly and correctly, and a full set of vitals indicated diverging BP of 200/40, pulse of 50 and normal resperations w/BVM. Skin was warm pink and clammy, pupils PERLL. We packaged and I indicated code 3 transport to nearest trauma center.
Where did I fail? They said because I never directly indicated unstable patient do to probably closed head injury, as indicated by the decorticate positioning and blood pressure. I have a couple of issues with this:
1. Even though I never mentioned the probability of closed head injury, I did indicate the need for priority, code 3 transport. Why would an specific diagnosis be critical? The signs and symptoms alone indicated the critical nature of the injury. Knowing the cause wouldn't have gotten the patient to the ER any faster.
2. The EMT course I took used the AAOS EMT-B textbook. Nowhere does it use the term decorticate positioning or say that diverging BP is a sign of closed head injury . It DOES mention abnormal flexion as part of the GCS scale, and obviously somebody positioning themselves like this is suffering from some sort of brain injury. The BP divergence is NOT mentioned.
I suspect this is not within the normal scope of EMT-B education, at least not in the AAOS book. Would somebody who took the course using the Brady (or similar) book PLEASE see if it is covered.
Again, I stated the need for priority transport and did nothing to endanger the patient. All other steps were performed correctly. Am I wrong to debate the failing grade?
